The maximum number of form submissions has been reached. This form is currently not available.

School(s) to which you are applying:
REQUIREDPlease fill out this field.Please enter valid data.

Grade level you prefer to teach in order of preference:
Please enter valid data.

Position for which you are applying:
REQUIREDPlease fill out this field.Please enter valid data.

Dear Applicant,

Please complete the entire application. The information requested is for bonafide occupational qualifications and/or is necessary to complete a security clearance. A resume is requested. Your resume, however, cannot be substituted for any information requested. You must complete this application. An incomplete application may result in your not being considered. Your application and all attachments become the property of the Diocese of Reno and cannot be returned. If you are hired, documentation showing eligibility for employment in the United States will be required. Please contact the Diocese of Reno or the school for which you are applying if you have any questions about completing this application.

If you need assistance during any step of the application and/or hiring process, please notify a representative from the Diocese of Reno in advance. Notification may be made in person or by telephoning (775)326-9430.

First Name
REQUIREDPlease fill out this field.Please enter valid data.

Last Name
REQUIREDPlease fill out this field.Please enter valid data.

Other Names Used
Please enter valid data.

Address
REQUIREDPlease fill out this field.Please enter valid data.

City
Please enter valid data.

State

Zip
Please enter a zip code.

Phone Number
REQUIREDPlease fill out this field.Please enter a phone number.

Email
REQUIREDPlease fill out this field.Please enter an email address.

Present Position or Status
Please enter valid data.

Religion
Please enter valid data.

If Catholic, what is your parish?
Please enter valid data.

May we contact your employer?
REQUIRED

Please note that it may be necessary to contact your current employer prior to an offer of employment. If you check NO, you will be notified prior to us contacting your current employer.

YESNOPlease fill out this field.

Have you previously applied for a position at the Diocese of Reno?
REQUIREDYESNOPlease fill out this field.

If YES when?
Please enter valid data.

If YES, why are you reapplying?
Please enter valid data.

Are you currently licensed by the Nevada State Board of Education to teach in Nevada?
REQUIREDYESNOPlease fill out this field.

Do you hold a valid license from another state?
REQUIREDYESNOPlease fill out this field.

If YES, name the state.
Please enter valid data.

Designate grade(s)/subject(s) you can teach in order of preference. Asterisk those you are CURRENTLY licensed to teach in NEVADA.
REQUIRED

In completing this section, please list only the grades and or subjects you are or may be licensed to teach.

Please fill out this field.

Please list any sports, activities or special subjects you are qualified to coach, advise or teach and give particulars of each in the two spaces below: (Note that if applying for a Physical Education position, you must have CPR Certification, recorded in personnel, prior to commencing employment.)

Athletic Coaching

e.g. soccer, tennis wrestling

Please enter valid data.

Student Activities

e.g. debate, yearbook, student government, drama, art

Please enter valid data.

Qualifications to teach religion.
Please enter valid data.

SECTION 1: ELEMENTARY LICENSE (K-8)

Grade level you prefer to teach in order of preference:
Please enter valid data.

Endorsements or areas of specialty:

SECTION 2: SECONDARY EDUCATION LICENSE (7-12)

Grade level(s) you prefer to teach:
Please enter valid data.

Major area(s) you are licensed or will be licensed to teach:
ArtBusinessCommunicationsDriver EdEnglishForeign LangugeMathMusicP.E.ScienceSocial Studies

SECTION 3: SPECIFIC SUBJECT AREAS

Please choose the specific area(s) you are or may be licensed to teach:

TEACHING EXPERIENCE Please account for
ALL teaching experience. You are required to provide complete and accurate information. Failure to do so may result in your application being rejected. Do NOT include student teaching in this section. Begin with most recent teaching employment.

Number of Teaching Experiences
REQUIRED

This number will duplicate the fields that many times

Please fill out this field.

Teaching Experience 1

Check all that apply:
Public SchoolPrivate SchoolSubstitute TeachingContracted TeachingPart-timeFull-timeTeam Teaching

School Name
Please enter valid data.

Address
Please enter valid data.

City
Please enter valid data.

State

Zip
Please enter a zip code.

Evaluator's name and title
Please enter valid data.

Evaluator's phone number
Please enter a phone number.

Subject(s)
Please enter valid data.

Grade(s)
Please enter valid data.

Dates of employment

From starting month/year to ending month/year

Please enter valid data.

Annual Salary
Please enter an integer (number).

Reason for leaving
Please enter valid data.

Teaching Experience 2

Check all that apply:
Public SchoolPrivate SchoolSubstitute TeachingContracted TeachingPart-timeFull-timeTeam Teaching

School Name
Please enter valid data.

Address
Please enter valid data.

City
Please enter valid data.

State

Zip
Please enter a zip code.

Evaluator's name and title
Please enter valid data.

Evaluator's phone number
Please enter a phone number.

Subject(s)
Please enter valid data.

Grade(s)
Please enter valid data.

Dates of employment

From starting month/year to ending month/year

Please enter valid data.

Annual Salary
Please enter an integer (number).

Reason for leaving
Please enter valid data.

Teaching Experience 3

Check all that apply:
Public SchoolPrivate SchoolSubstitute TeachingContracted TeachingPart-timeFull-timeTeam Teaching

School Name
Please enter valid data.

Address
Please enter valid data.

City
Please enter valid data.

State

Zip
Please enter a zip code.

Evaluator's name and title
Please enter valid data.

Evaluator's phone number
Please enter a phone number.

Subject(s)
Please enter valid data.

Grade(s)
Please enter valid data.

Dates of employment

From starting month/year to ending month/year

Please enter valid data.

Annual Salary
Please enter an integer (number).

Reason for leaving
Please enter valid data.

Teaching Experience 4

Check all that apply:
Public SchoolPrivate SchoolSubstitute TeachingContracted TeachingPart-timeFull-timeTeam Teaching

School Name
Please enter valid data.

Address
Please enter valid data.

City
Please enter valid data.

State

Zip
Please enter a zip code.

Evaluator's name and title
Please enter valid data.

Evaluator's phone number
Please enter a phone number.

Subject(s)
Please enter valid data.

Grade(s)
Please enter valid data.

Dates of employment

From starting month/year to ending month/year

Please enter valid data.

Annual Salary
Please enter an integer (number).

Reason for leaving
Please enter valid data.

Teaching Experience 5

Check all that apply:
Public SchoolPrivate SchoolSubstitute TeachingContracted TeachingPart-timeFull-timeTeam Teaching

School Name
Please enter valid data.

Address
Please enter valid data.

City
Please enter valid data.

State

Zip
Please enter a zip code.

Evaluator's name and title
Please enter valid data.

Evaluator's phone number
Please enter a phone number.

Subject(s)
Please enter valid data.

Grade(s)
Please enter valid data.

Dates of employment

From starting month/year to ending month/year

Please enter valid data.

Annual Salary
Please enter an integer (number).

Reason for leaving
Please enter valid data.

Teaching Experience 6

Check all that apply:
Public SchoolPrivate SchoolSubstitute TeachingContracted TeachingPart-timeFull-timeTeam Teaching

School Name
Please enter valid data.

Address
Please enter valid data.

City
Please enter valid data.

State

Zip
Please enter a zip code.

Evaluator's name and title
Please enter valid data.

Evaluator's phone number
Please enter a phone number.

Subject(s)
Please enter valid data.

Grade(s)
Please enter valid data.

Dates of employment

From starting month/year to ending month/year

Please enter valid data.

Annual Salary
Please enter an integer (number).

Reason for leaving
Please enter valid data.

Teaching Experience 7

Check all that apply:
Public SchoolPrivate SchoolSubstitute TeachingContracted TeachingPart-timeFull-timeTeam Teaching

School Name
Please enter valid data.

Address
Please enter valid data.

City
Please enter valid data.

State

Zip
Please enter a zip code.

Evaluator's name and title
Please enter valid data.

Evaluator's phone number
Please enter a phone number.

Subject(s)
Please enter valid data.

Grade(s)
Please enter valid data.

Dates of employment

From starting month/year to ending month/year

Please enter valid data.

Annual Salary
Please enter an integer (number).

Reason for leaving
Please enter valid data.

Teaching Experience 8

Check all that apply:
Public SchoolPrivate SchoolSubstitute TeachingContracted TeachingPart-timeFull-timeTeam Teaching

School Name
Please enter valid data.

Address
Please enter valid data.

City
Please enter valid data.

State

Zip
Please enter a zip code.

Evaluator's name and title
Please enter valid data.

Evaluator's phone number
Please enter a phone number.

Subject(s)
Please enter valid data.

Grade(s)
Please enter valid data.

Dates of employment

From starting month/year to ending month/year

Please enter valid data.

Annual Salary
Please enter an integer (number).

Reason for leaving
Please enter valid data.

Teaching Experience 9

Check all that apply:
Public SchoolPrivate SchoolSubstitute TeachingContracted TeachingPart-timeFull-timeTeam Teaching

School Name
Please enter valid data.

Address
Please enter valid data.

City
Please enter valid data.

State

Zip
Please enter a zip code.

Evaluator's name and title
Please enter valid data.

Evaluator's phone number
Please enter a phone number.

Subject(s)
Please enter valid data.

Grade(s)
Please enter valid data.

Dates of employment

From starting month/year to ending month/year

Please enter valid data.

Annual Salary
Please enter an integer (number).

Reason for leaving
Please enter valid data.

Teaching Experience 10

Check all that apply:
Public SchoolPrivate SchoolSubstitute TeachingContracted TeachingPart-timeFull-timeTeam Teaching

School Name
Please enter valid data.

Address
Please enter valid data.

City
Please enter valid data.

State

Zip
Please enter a zip code.

Evaluator's name and title
Please enter valid data.

Evaluator's phone number
Please enter a phone number.

Subject(s)
Please enter valid data.

Grade(s)
Please enter valid data.

Dates of employment

From starting month/year to ending month/year

Please enter valid data.

Annual Salary
Please enter an integer (number).

Reason for leaving
Please enter valid data.

Teaching Experience 11

Check all that apply:
Public SchoolPrivate SchoolSubstitute TeachingContracted TeachingPart-timeFull-timeTeam Teaching

School Name
Please enter valid data.

Address
Please enter valid data.

City
Please enter valid data.

State

Zip
Please enter a zip code.

Evaluator's name and title
Please enter valid data.

Evaluator's phone number
Please enter a phone number.

Subject(s)
Please enter valid data.

Grade(s)
Please enter valid data.

Dates of employment

From starting month/year to ending month/year

Please enter valid data.

Annual Salary
Please enter an integer (number).

Reason for leaving
Please enter valid data.

Teaching Experience 12

Check all that apply:
Public SchoolPrivate SchoolSubstitute TeachingContracted TeachingPart-timeFull-timeTeam Teaching

School Name
Please enter valid data.

Address
Please enter valid data.

City
Please enter valid data.

State

Zip
Please enter a zip code.

Evaluator's name and title
Please enter valid data.

Evaluator's phone number
Please enter a phone number.

Subject(s)
Please enter valid data.

Grade(s)
Please enter valid data.

Dates of employment

From starting month/year to ending month/year

Please enter valid data.

Annual Salary
Please enter an integer (number).

Reason for leaving
Please enter valid data.

OTHER EMPLOYMENT/MILITARY EXPERIENCE

Please account for the LAST 10 YEARS of employment if you have not already done so in the TEACHING EXPERIENCE section.

Number of Other Employment/Military Service
REQUIREDPlease fill out this field.

Employer 1

Employer
Please enter valid data.

Address
Please enter valid data.

City
Please enter valid data.

State

Zip
Please enter a zip code.

Supervisor's name and title
Please enter valid data.

Supervisor's phone number
Please enter valid data.

Type of work/title
Please enter valid data.

Major responsibilities and % of time spent on each

Choose one:

If Part-time (less than 40 hours/week), how many hours a week?
Please enter valid data.

Dates of Employment:
Please enter valid data.

Salary
Please enter valid data.

Reason for leaving.
Please enter valid data.

Employer 2

Employer
Please enter valid data.

Address
Please enter valid data.

City
Please enter valid data.

State

Zip
Please enter a zip code.

Supervisor's name and title
Please enter valid data.

Supervisor's phone number
Please enter valid data.

Type of work/title
Please enter valid data.

Major responsibilities and % of time spent on each

Choose one:

If Part-time (less than 40 hours/week), how many hours a week?
Please enter valid data.

Dates of Employment:
Please enter valid data.

Salary
Please enter valid data.

Reason for leaving.
Please enter valid data.

Employer 3

Employer
Please enter valid data.

Address
Please enter valid data.

City
Please enter valid data.

State

Zip
Please enter a zip code.

Supervisor's name and title
Please enter valid data.

Supervisor's phone number
Please enter valid data.

Type of work/title
Please enter valid data.

Major responsibilities and % of time spent on each

Choose one:

If Part-time (less than 40 hours/week), how many hours a week?
Please enter valid data.

Dates of Employment:
Please enter valid data.

Salary
Please enter valid data.

Reason for leaving.
Please enter valid data.

Employer 4

Employer
Please enter valid data.

Address
Please enter valid data.

City
Please enter valid data.

State

Zip
Please enter a zip code.

Supervisor's name and title
Please enter valid data.

Supervisor's phone number
Please enter valid data.

Type of work/title
Please enter valid data.

Major responsibilities and % of time spent on each

Choose one:

If Part-time (less than 40 hours/week), how many hours a week?
Please enter valid data.

Dates of Employment:
Please enter valid data.

Salary
Please enter valid data.

Reason for leaving.
Please enter valid data.

Employer 5

Employer
Please enter valid data.

Address
Please enter valid data.

City
Please enter valid data.

State

Zip
Please enter a zip code.

Supervisor's name and title
Please enter valid data.

Supervisor's phone number
Please enter valid data.

Type of work/title
Please enter valid data.

Major responsibilities and % of time spent on each

Choose one:

If Part-time (less than 40 hours/week), how many hours a week?
Please enter valid data.

Dates of Employment:
Please enter valid data.

Salary
Please enter valid data.

Reason for leaving.
Please enter valid data.

Employer 6

Employer
Please enter valid data.

Address
Please enter valid data.

City
Please enter valid data.

State

Zip
Please enter a zip code.

Supervisor's name and title
Please enter valid data.

Supervisor's phone number
Please enter valid data.

Type of work/title
Please enter valid data.

Major responsibilities and % of time spent on each

Choose one:

If Part-time (less than 40 hours/week), how many hours a week?
Please enter valid data.

Dates of Employment:
Please enter valid data.

Salary
Please enter valid data.

Reason for leaving.
Please enter valid data.

Employer 7

Employer
Please enter valid data.

Address
Please enter valid data.

City
Please enter valid data.

State

Zip
Please enter a zip code.

Supervisor's name and title
Please enter valid data.

Supervisor's phone number
Please enter valid data.

Type of work/title
Please enter valid data.

Major responsibilities and % of time spent on each

Choose one:

If Part-time (less than 40 hours/week), how many hours a week?
Please enter valid data.

Dates of Employment:
Please enter valid data.

Salary
Please enter valid data.

Reason for leaving.
Please enter valid data.

Employer 8

Employer
Please enter valid data.

Address
Please enter valid data.

City
Please enter valid data.

State

Zip
Please enter a zip code.

Supervisor's name and title
Please enter valid data.

Supervisor's phone number
Please enter valid data.

Type of work/title
Please enter valid data.

Major responsibilities and % of time spent on each

Choose one:

If Part-time (less than 40 hours/week), how many hours a week?
Please enter valid data.

Dates of Employment:
Please enter valid data.

Salary
Please enter valid data.

Reason for leaving.
Please enter valid data.

Employer 9

Employer
Please enter valid data.

Address
Please enter valid data.

City
Please enter valid data.

State

Zip
Please enter a zip code.

Supervisor's name and title
Please enter valid data.

Supervisor's phone number
Please enter valid data.

Type of work/title
Please enter valid data.

Major responsibilities and % of time spent on each

Choose one:

If Part-time (less than 40 hours/week), how many hours a week?
Please enter valid data.

Dates of Employment:
Please enter valid data.

Salary
Please enter valid data.

Reason for leaving.
Please enter valid data.

Employer 10

Employer
Please enter valid data.

Address
Please enter valid data.

City
Please enter valid data.

State

Zip
Please enter a zip code.

Supervisor's name and title
Please enter valid data.

Supervisor's phone number
Please enter valid data.

Type of work/title
Please enter valid data.

Major responsibilities and % of time spent on each

Choose one:

If Part-time (less than 40 hours/week), how many hours a week?
Please enter valid data.

Dates of Employment:
Please enter valid data.

Salary
Please enter valid data.

Reason for leaving.
Please enter valid data.

Employer 11

Employer
Please enter valid data.

Address
Please enter valid data.

City
Please enter valid data.

State

Zip
Please enter a zip code.

Supervisor's name and title
Please enter valid data.

Supervisor's phone number
Please enter valid data.

Type of work/title
Please enter valid data.

Major responsibilities and % of time spent on each

Choose one:

If Part-time (less than 40 hours/week), how many hours a week?
Please enter valid data.

Dates of Employment:
Please enter valid data.

Salary
Please enter valid data.

Reason for leaving.
Please enter valid data.

Employer 12

Employer
Please enter valid data.

Address
Please enter valid data.

City
Please enter valid data.

State

Zip
Please enter a zip code.

Supervisor's name and title
Please enter valid data.

Supervisor's phone number
Please enter valid data.

Type of work/title
Please enter valid data.

Major responsibilities and % of time spent on each

Choose one:

If Part-time (less than 40 hours/week), how many hours a week?
Please enter valid data.

Dates of Employment:
Please enter valid data.

Salary
Please enter valid data.

Reason for leaving.
Please enter valid data.

EDUCATION AND TRAINING

Choose highest grade completed
REQUIREDPlease fill out this field.

Specify diploma/degree
Please enter valid data.

Elementary/High School

Name and location of last school attended.

Please enter valid data.

Did you Graduate?
REQUIREDYESNOPlease fill out this field.

High school equivalent: successful completion of

If you chose Other for High school equivalent, please specify.
Please enter valid data.

College, University, Professional or Technical School (List all undergraduate and graduate work. Please provide official transcripts verifying credits an degrees.)

Number of Degrees (including in-progress)
REQUIRED

The form will duplicate for each degree.

Please fill out this field.

Degree Information 1

Degree Received
Please enter valid data.

Date
Please enter valid data.

Major
Please enter valid data.

Minor
Please enter valid data.

Institution
Please enter valid data.

Location
Please enter valid data.

Dates of Enrollment
Please enter valid data.

Number of Credits

Quarter hours x 2/3 = semester hours.

Please enter valid data.

Degree Information 2

Degree Received
Please enter valid data.

Date
Please enter valid data.

Major
Please enter valid data.

Minor
Please enter valid data.

Institution
Please enter valid data.

Location
Please enter valid data.

Dates of Enrollment
Please enter valid data.

Number of Credits

Quarter hours x 2/3 = semester hours.

Please enter valid data.

Degree Information 3

Degree Received
Please enter valid data.

Date
Please enter valid data.

Major
Please enter valid data.

Minor
Please enter valid data.

Institution
Please enter valid data.

Location
Please enter valid data.

Dates of Enrollment
Please enter valid data.

Number of Credits

Quarter hours x 2/3 = semester hours.

Please enter valid data.

Degree Information 4

Degree Received
Please enter valid data.

Date
Please enter valid data.

Major
Please enter valid data.

Minor
Please enter valid data.

Institution
Please enter valid data.

Location
Please enter valid data.

Dates of Enrollment
Please enter valid data.

Number of Credits

Quarter hours x 2/3 = semester hours.

Please enter valid data.

Degree Information 5

Degree Received
Please enter valid data.

Date
Please enter valid data.

Major
Please enter valid data.

Minor
Please enter valid data.

Institution
Please enter valid data.

Location
Please enter valid data.

Dates of Enrollment
Please enter valid data.

Number of Credits

Quarter hours x 2/3 = semester hours.

Please enter valid data.

Degree Information 6

Degree Received
Please enter valid data.

Date
Please enter valid data.

Major
Please enter valid data.

Minor
Please enter valid data.

Institution
Please enter valid data.

Location
Please enter valid data.

Dates of Enrollment
Please enter valid data.

Number of Credits

Quarter hours x 2/3 = semester hours.

Please enter valid data.

Degree Information 7

Degree Received
Please enter valid data.

Date
Please enter valid data.

Major
Please enter valid data.

Minor
Please enter valid data.

Institution
Please enter valid data.

Location
Please enter valid data.

Dates of Enrollment
Please enter valid data.

Number of Credits

Quarter hours x 2/3 = semester hours.

Please enter valid data.

Degree Information 8

Degree Received
Please enter valid data.

Date
Please enter valid data.

Major
Please enter valid data.

Minor
Please enter valid data.

Institution
Please enter valid data.

Location
Please enter valid data.

Dates of Enrollment
Please enter valid data.

Number of Credits

Quarter hours x 2/3 = semester hours.

Please enter valid data.

I have completed my student teaching.
REQUIREDYESNOPlease fill out this field.

Dates
Please enter valid data.

REFERENCES

Is placement file being sent?
REQUIREDYESNOPlease fill out this field.

A resume or placement file may not be substituted for this section. Please list four references (do not include relatives or neighbors) who are familiar with your work experience, character, education and general abilities. At least two of these must be current or previous supervisors (please asterisk*).

Reference 1

First Name
REQUIREDPlease fill out this field.Please enter valid data.

Last Name
REQUIREDPlease fill out this field.Please enter valid data.

Title
REQUIREDPlease fill out this field.Please enter valid data.

Phone Number
REQUIREDPlease fill out this field.Please enter a phone number.

Address
REQUIREDPlease fill out this field.Please enter valid data.

City
REQUIREDPlease fill out this field.Please enter valid data.

State
REQUIREDPlease fill out this field.

Zip
REQUIREDPlease fill out this field.Please enter a zip code.

Reference 2

First Name
REQUIREDPlease fill out this field.Please enter valid data.

Last Name
REQUIREDPlease fill out this field.Please enter valid data.

Title
REQUIREDPlease fill out this field.Please enter valid data.

Phone Number
REQUIREDPlease fill out this field.Please enter a phone number.

Address
REQUIREDPlease fill out this field.Please enter valid data.

City
REQUIREDPlease fill out this field.Please enter valid data.

State
REQUIREDPlease fill out this field.

Zip
REQUIREDPlease fill out this field.Please enter a zip code.

Reference 3

First Name
REQUIREDPlease fill out this field.Please enter valid data.

Last Name
REQUIREDPlease fill out this field.Please enter valid data.

Title
REQUIREDPlease fill out this field.Please enter valid data.

Phone Number
REQUIREDPlease fill out this field.Please enter a phone number.

Address
REQUIREDPlease fill out this field.Please enter valid data.

City
REQUIREDPlease fill out this field.Please enter valid data.

State
REQUIREDPlease fill out this field.

Zip
REQUIREDPlease fill out this field.Please enter a zip code.

Reference 4

First Name
REQUIREDPlease fill out this field.Please enter valid data.

Last Name
REQUIREDPlease fill out this field.Please enter valid data.

Title
REQUIREDPlease fill out this field.Please enter valid data.

Phone Number
REQUIREDPlease fill out this field.Please enter a phone number.

Address
REQUIREDPlease fill out this field.Please enter valid data.

City
REQUIREDPlease fill out this field.Please enter valid data.

State
REQUIREDPlease fill out this field.

Zip
REQUIREDPlease fill out this field.Please enter a zip code.

PREVIOUS RESIGNATION/DISMISSAL INFORMATION

If you have been dismissed, terminated, asked to resign, or asked to resign in lieu of discipline by a previous (or current) employer, or if you are under investigation by your current employer for possible disciplinary action, a full and complete explanation must be addressed to the attention of the school principal or the Superintendent of Catholic Schools, Diocese of Reno. Please place your written explanation in a sealed envelope and attach it to your application.

ARRESTS/CONVICTIONS

In answering the following questions, be advised that if you are offered employment with any school in the Diocese of Reno, a criminal background check is required. The Diocese of Reno reserves the right to request fingerprints to be processed. It is essential, therefore, that you answer each question with complete honesty. If you are unsure about a past event, you should list it. Please note that a “yes” answer to these questions may not necessarily disqualify you from consideration for employment. The Diocese will consider the nature and date of the conviction, your intervening conduct, and the relationship between the conviction and the position for which you are applying.

Have you ever been CONVICTED of any criminal offense other than a minor traffic violation (this includes, but is not limited to a felony, gross misdemeanor, misdemeanor, DUI, etc.)? Conviction means the final judgment of a verdict or a finding of guilty, plea of guilty, or a plea of nolo contendre in any court, regardless of whether an appeal is pending or could be taken.

Have you ever been CONVICTED of any criminal offense other than a minor traffic violation?
REQUIRED

This includes, but is not limited to a felony, gross misdemeanor, misdemeanor, DUI, etc. Conviction means the final judgment of a verdict or a finding of guilty, plea of guilty, or a plea of nolo contendre in any court, regardless of whether an appeal is pending or could be taken.

YESNOPlease fill out this field.

Do you have any outstanding arrests for which you are awaiting trial or for which a final judicial determination has not been made?
REQUIREDYESNOPlease fill out this field.

If YES to EITHER of the above questions, you must fill out the CONVICTION INFORMATION below and agree to the terms. Failure to do so may result in the rejection of your application.

Number of arrests:
REQUIREDPlease fill out this field.

Conviction 1

Date of Arrest
Please enter valid data.

Arresting Agency

Police/Sheriff and location

Please enter valid data.

Arrest Charge
Please enter valid data.

Charge for which you where convicted.
Please enter valid data.

Date of Conviction

mm/yy

Please enter valid data.

Penalty Imposed
Please enter valid data.

Explain the circumstances surrounding the conviction.

This information will be reviewed in considering you for this position.

Conviction 2

Date of Arrest
Please enter valid data.

Arresting Agency

Police/Sheriff and location

Please enter valid data.

Arrest Charge
Please enter valid data.

Charge for which you where convicted.
Please enter valid data.

Date of Conviction

mm/yy

Please enter valid data.

Penalty Imposed
Please enter valid data.

Explain the circumstances surrounding the conviction.

This information will be reviewed in considering you for this position.

Conviction 3

Date of Arrest
Please enter valid data.

Arresting Agency

Police/Sheriff and location

Please enter valid data.

Arrest Charge
Please enter valid data.

Charge for which you where convicted.
Please enter valid data.

Date of Conviction

mm/yy

Please enter valid data.

Penalty Imposed
Please enter valid data.

Explain the circumstances surrounding the conviction.

This information will be reviewed in considering you for this position.

Conviction 4

Date of Arrest
Please enter valid data.

Arresting Agency

Police/Sheriff and location

Please enter valid data.

Arrest Charge
Please enter valid data.

Charge for which you where convicted.
Please enter valid data.

Date of Conviction

mm/yy

Please enter valid data.

Penalty Imposed
Please enter valid data.

Explain the circumstances surrounding the conviction.

This information will be reviewed in considering you for this position.

Conviction 5

Date of Arrest
Please enter valid data.

Arresting Agency

Police/Sheriff and location

Please enter valid data.

Arrest Charge
Please enter valid data.

Charge for which you where convicted.
Please enter valid data.

Date of Conviction

mm/yy

Please enter valid data.

Penalty Imposed
Please enter valid data.

Explain the circumstances surrounding the conviction.

This information will be reviewed in considering you for this position.

Conviction 6

Date of Arrest
Please enter valid data.

Arresting Agency

Police/Sheriff and location

Please enter valid data.

Arrest Charge
Please enter valid data.

Charge for which you where convicted.
Please enter valid data.

Date of Conviction

mm/yy

Please enter valid data.

Penalty Imposed
Please enter valid data.

Explain the circumstances surrounding the conviction.

This information will be reviewed in considering you for this position.

I certify that the above information represents a true and correct record of my conviction history. I understand this information will not automatically exclude me from consideration of employment. Furthermore, I understand any false statements or failure to disclose information may be sufficient to disqualify me for employment, or if employed, may result in my dismissal.

I AgreePlease select this field.

Have you ever had any credential or driver's license suspended or revoked?
REQUIREDYESNOPlease fill out this field.

If YES please explain and include applicable dates.

PLEASE READ THE FOLLOWING CAREFULLY AND CHECK THE "AGREE" BOX.

I hereby certify that all information provided by me on this employment application and all other information provided by me in the course of applying for employment with the Diocese of Reno Department of Education is truthful, accurate, and complete. I understand that if any information provided to me on this employment application or any other information provided by me in the course of applying for employment with the Diocese of Reno is found to be false, untruthful, misleading, or incomplete that such will be cause for immediate rejection of my application for employment. I further understand that if I am hired as an employee in the Diocese of Reno and at any time thereafter it is discovered that any information provided by me on this employment application or any other information provided by me in the course of applying for employment with the Diocese of Reno Department of Education is found to be false, untruthful, misleading, or incomplete shall be sufficient cause for disqualification or dismissal from employment.

I hereby authorize the Diocese of Reno to obtain information relating to my current and previous employment, education, criminal or personal history records. I agree to release the Diocese of Reno, its employees, representatives, and agents from any and all liability claims or damages for the obtaining and use of information obtained from these sources or developed as a result of contacting these sources.

I hereby authorize any and all organizations, including but not limited to my current or previous employers, educational institutions, etc., their employees, representatives, and agents to provide any and all information regarding my employment or education to the Diocese of Reno, its employees, representatives, and agents from any and all liability claims or damages that may directly or indirectly result from the use, disclosure, release or omission of any such information by and person or party, whether such information is favorable or unfavorable to me. A photocopy of this release will be valid as an original even though the photocopy does not contain an original writing of my signature.

I hereby certify that I have read and understand the above.

I AgreePlease select this field.

DIOCESE OF RENO DEPARTMENT OF EDUCATION

LICENSURE INFORMATION

Thank you for your interest in the school(s) of the Diocese of Reno. This information is supplied as a courtesy to the applicant. In order to receive a Teaching or an Administrative contract, the applicant must hold a valid license in the State of Nevada.

Responsibility for securing, maintaining and reviewing licenses rests solely with the professional employee.

Please refer to the State of Nevada Licensure webpage for the most current requirements and procedures: http://teachers.nv.gov/

IMMIGRATION REFORM AND CONTROL ACT

IMPORTANT NOTICE

This law is intended to prevent employers from knowingly hiring illegal aliens and contains severe civil and criminal penalties for violations.

This law requires us to examine certain documents you must show to (1) establish your identity and (2) confirm that you are legally entitled to work in the United States.

Below and on the back side of this sheet is a list of documents you can show in order to meet requirements of this law. In the event you are employed by this School, please be advised that you will be asked to provide the necessary documents within 24 hours of the time you are offered employment.

If you are employed by this School on the basis of acceptable documentation of your status, the law will require you to sign a government form affirming the nature of documents you presented and that they are genuine. Your failure or refusal to sign such a statement when requested will result in your immediate suspension so that you can reconsider your refusal and be reminded of the law. Continued refusal will result in your termination.

ACCEPTABLE DOCUMENTS. The individual may present either a document which established both employment authorization or identity as defined in 274A(b)(1)(B) of the Act or an original document which establishes employment authorization as defined in 274A(b)(1)(C) and a separate original document which establishes identity as defined in 274(b)(1)(D).

The following are acceptable documents to establish both identity and employment authorization (for the purpose of 274(b)(1)(B):

United States passport

Certificate of Citizenship, issued by the U.S. Immigration and Naturalization Service.

U.S. Citizen Identification Card, issued by the U.S. Immigration and Naturalization Service. Certificate of Naturalization.

has attached thereto a FormI-94 in the same name (with identical biographic information) on which is an employment authorization stamp so long as the period so long as the period of endorsement has not yet expired and the limitations identified on the Form I-94.

An Alien Registration Card, provided that it contains a photograph of the bearer.

A current Work Permit, issued by the U.S. Immigration and Naturalization Service.

2. The following are acceptable documents to establish employment authorization (for purposes of 274(b)(1)(C):

Social Security account number card, issued by the Department of Health and Human Services or previously issued by Health, Education and Welfare (other than such a card which specified on the face that the issuance of the card does not authorize employment in the United States).

A certificate of birth in any State. The certificate must contain the given surname, name, date of birth, place of birth, a date the birth record was filed, and an official seal or other certification by the official custodian of such record. Official custodian refers to the governmental agency with which the birth is registered.

Report of U.S. Citizenship Birth Abroad, issued by the U.S. Department of State. D. Form I-94 with employment authorization stamp.

3. The following are acceptable for the purpose of establishing identity of the individual (for the purposes of 274A(b)(1)(d):

An original driver’s license issued by any state which:

bearsaphotographoftheindividual,or

contains personal identifying information which, at a minimum, includes his/her full name, date of birth, height, weight, color of eyes, and residence address.

An original identity document issued by any State (or for the purpose of identification which either:

bears a photograph of the individual, or

contains personal identifying information which, at a minimum, includes his/her full name, date of birth, height, weight, color of eyes, and residence address.

In the case of individuals residing in a state which does not provide for issuance of an identification document (other than a driver’s license), the following:

Notice of discharge from the U.S. Armed Forces.

Document evidencing active duty or reserve status in the U.S. Armed Forces.

(to be developed)

EMPLOYMENT QUESTIONNAIRE

The completion of this questionnaire is completely VOLUNTARY. The information on this questionnaire will be used by the school and the diocese for research and statistical purposes only. This questionnaire will be kept confidential and will not be used to make any employment decision.